Don’t bet against a Medicaid deal in Richmond

January 7

Right now, the smart money in Richmond is betting that incoming governor Terry McAuliffe will fail to deliver on his campaign promise to expand Medicaid. This past weekend, Republican House Speaker Bill Howell said again that “Medicaid should not be expanded.” This joint state-federal program to provide health care to those with low incomes and scant resources is Virginia’s fastest growing budget item. Our sources confirm that Howell speaks for the GOP General Assembly leadership.

Providing the poor with access to quality health care is a Democratic Party holy grail. When Obamacare passed, fully expanding Medicaid was non-negotiable.  But the Supreme Court decision upholding the law fundamentally changed the rules by giving Richmond, and not Washington, the final say on Medicaid expansion.

The state budget expires on June 30. If McAuliffe and Howell can’t bridge their differences, state government has no money on July 1. Are we headed for a Washington-style shutdown fight due to a Medicaid meltdown?

Our view: Do the supposedly dumb thing and bet against the smart money. Bill Howell and Senate Democratic leader Dick Saslaw are arguably the best big-game duo we’ve seen in the modern two-party era in Virginia. They understand the unwritten rule: A new governor can’t be left holding an empty bag on his biggest campaign pledge.

Rep. Eric Cantor, the GOP majority leader in the House of Representatives, provided fellow Virginia Republicans with this advice at their recent annual meeting at the Homestead Resort:

“We Republicans are and have always been the party dedicated to self-reliance and opportunity for all. That opportunity starts with a good education. Our party should be the education party – period.”

How does this relate to Medicaid?

A 2009 Pentagon-backed report revealed that “over half of young adults” are disqualified from military service “because of health issues,” not including those unfit due to drug or alcohol problems.  The correlation between good health and academic achievement is long documented. A “Medicaid for Dems, education for Republicans” win-win makes perfect sense. But four other options dominate backroom discussions.

‘Hell, no’: Some want House Republicans to reject any new budget incorporating a Medicaid expansion. The Senate, joining with McAuliffe, would refuse, blaming Howell for risking a Washington-style government shutdown. It could ruin the House GOP.

Symbolic expansion: This strategy appeals to some House Republicans. But no matter who wins the special elections for Senate seats now held by Lt.-Gov.-elect Ralph Northam and Attorney General-elect Mark Herring, Saslaw will maintain de facto control on this issue, given that at least two Republicans —  Sen. John Watkins and Sen. Emmet Hanger — have both voiced their support for Medicaid expansion and the Democrats have the tie-breaking vote in the lieutenant governor. Saslaw will not hand McAuliffe a Medicaid fig leaf.

Full expansion: Saslaw could muscle full expansion through the Senate. But Howell has already said that Republicans will be proposing responsible alternatives to address health care for the needy. Saslaw knows that such options would give the speaker great leverage. He’s not likely to overreach.

The McDonnell Sweetspot: Despite his legal troubles, Gov. Bob McDonnell maintains remarkably high job approval ratings. His suggestion to sunset any Medicaid expansion after two years – during which time Uncle Sam would cover 100 percent of the increased cost — is a perfect example of why. He has a knack for finding a policy “sweet spot,” not a dead zone.

Medicaid is a means to an end, not an end in itself. One example: Studies show that kids on Medicaid aren’t currently getting required care. Expansion alone is no magic elixir. One envelope-pushing solution: Mandate that Virginia students get periodic health exams, using innovative public/private/nonprofit solutions proven to work where Medicaid is falling short.

Conclusion 

McAuliffe’s team understands the Medicaid stakes: There is no second chance for a first impression. The legislative showdown can make or break his image. There is no legal requirement to resolve every issue this year. Genuine progress will suffice. Howell and Saslaw are savvy dance partners.

Access to affordable, quality care has gone from a luxury to a fundamental part of America’s social contract. But money doesn’t grow on trees. A bipartisan agreement to buy time to explore innovative reforms makes education, fiscal and health-care sense.

Norman Leahy is an editor of the conservative Web site BearingDrift.com and producer of the political radio show “The Score.” Paul Goldman is a former chairman of the Democratic Party of Virginia. They are blogging together on All Opinions Are Local during Virginia’s 2014 General Assembly session.

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